BRACHIAL APPROACH FOR INTRACORONARY STENT IMPLANTATION - A FEASIBILITY STUDY

Implantation of coronary artery stents via the percutaneous femoral ap proach is associated with a high rate of vascular complications at the access site related to the size of the entry hole and the intense ant icoagulation required to prevent stent thrombosis. Therefore we studie d the feasibility of using the left brachial approach utilizing open a rterial repair for implantation of coronary artery stents. Intracorona ry stent implantation via the femoral approach in 24 patients (group A ) was compared with implantation via the brachial approach in 16 patie nts (group B). Baseline lesion characteristics were similar in the two groups. All stents in group A (n = 27 stents) were successfully deliv ered to their target vessel. One stent in group B (n = 18 stents) coul d not be delivered because of an inability to engage the coronary arte ry from the brachial approach. There were no significant differences i n the angiographic outcome between the two groups. Complications inclu ding hematomas, hemorrhage requiring blood transfusion, vascular injur y requiring surgery, and pseudoaneurysm formation were significantly m ore common in group A than in group B (8/24 33%! versus 1/16 6%!, re spectively; p < 0.05). In addition, the length of hospital stay was si gnificantly longer for the femoral approach than the brachial approach (9.4 vs 6.5 days, respectively; p < 0.05). Thus the left brachial app roach for intracoronary stent implantation is technically feasible, sa fe, and associated with fewer local vascular complications and a short er hospitalization than the femoral approach.